The Ministry of Health has revealed that 4.3 million Kenyans who transitioned from the National Health Insurance Fund (NHIF) to the newly established Social Health Authority (SHA) have yet to update their profiles. This delay poses a serious challenge, as it prevents these individuals from accessing crucial benefits such as the Social Health Insurance Fund (SHIF) and the Chronic and Critical Care Fund.
In a recent statement, Dr. Patrick Amoth, the Director General of Health, emphasized the importance of profile updates for all SHA members. The updated information is critical for determining eligibility and ensuring smooth access to healthcare services when required.
As of now, 18.8 million Kenyans have enrolled in SHA, yet registration numbers significantly dip over weekends. Dr. Amoth pointed out that during weekends, only 26,000 people on average update their records daily, compared to 75,000 during weekdays. He expressed concern that many individuals are only registering when they seek healthcare services, which is not an ideal approach. “Kenyans should be encouraged to register for SHA proactively, much like they do with any other insurance service,” he remarked.
Another key issue highlighted was the low participation in means-testing, a process that determines the appropriate premium for those who are not formally employed. While 3.1 million individuals have completed means-testing, many others remain ineligible for advanced services under SHIF or the Chronic and Critical Care Fund. Dr. Amoth noted that these individuals can only access basic primary healthcare and emergency services.
Regional disparities in registration also exist. Counties like Mombasa, Elgeyo Marakwet, and Bomet have the highest registration rates, with figures exceeding 40%, while regions such as Turkana, West Pokot, Garissa, and Samburu are lagging behind. Additionally, the health facility registration rate is at 56%, with challenges faced at dispensaries and health centers, where manual documentation has been traditionally relied upon.
To mitigate these challenges, the Ministry of Health has deployed support teams to assist counties in improving registration processes. Over the past four months, the SHA has facilitated over 1 million primary healthcare visits, and claims totaling Sh18 billion have been submitted, including Sh12.2 billion from private and faith-based facilities.
Dr. Amoth noted improvements in the turnaround time for pre-authorizations, which have reduced significantly from 526 minutes to just 76 minutes. The SHA continues to refine its processes to ensure that more Kenyans can access timely and comprehensive healthcare.
As Kenya works towards achieving universal healthcare coverage, timely profile updates and registration remain pivotal to ensuring that no one is left behind in accessing essential health services.
